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目的探讨严重肝病并发自发性细菌性腹膜炎(SBP)的早期诊断和早期治疗,为临床合理有效使用抗菌药物提供科学依据。方法回顾性分析我院近7年来212例严重肝病合并SBP患者的临床表现、病原学检查,药敏试验结果。结果212例肝病患者中有180例(85%)有腹胀,164例(77%)有腹部压痛或反跳痛;146例(69%)有发热,104例(49%)有自觉腹痛,88例(42%)有腹泻。108例(51%)腹水白细胞≥0.5×109/L;74例(35%)腹水白细胞≥0.3×109/L;PMN(腹水多形核白细胞)≥0.5者122例(58%),PMN≥0.25者90例(42%)。32例(15%)腹水细菌培养阳性,共分离细菌16株,6种细菌,革兰阴性菌占88%,革兰阳性菌占12%。结论肝病患者并发SBP者临床表现多样,腹水细菌培养阳性率低,PMN比值是诊断SBP的可靠指标。病原菌以革兰阴性菌为主,对第三代头孢、第三代喹诺酮抗生素敏感。
Objective To explore the early diagnosis and early treatment of severe liver disease complicated with spontaneous bacterial peritonitis (SBP) and provide a scientific basis for rational and effective use of antibacterials in clinical practice. Methods A retrospective analysis of 212 cases of severe liver disease with SBP in our hospital over the past 7 years clinical manifestations, etiological examination, drug susceptibility test results. Results Of the 212 patients with liver disease, 180 (85%) had abdominal distension, 164 (77%) had abdominal tenderness or rebound tenderness, 146 (69%) had fever, 104 (49% Cases (42%) had diarrhea. 108 cases (51%) ascites white blood cells ≥0.5 × 109 / L; 74 cases (35%) ascites white blood cells ≥0.3 × 109 / L; 122 cases (58%) PMN 0.25 in 90 cases (42%). 32 (15%) ascites bacteria culture positive, a total of 16 bacteria were isolated, 6 kinds of bacteria, Gram-negative bacteria accounted for 88%, Gram-positive bacteria accounted for 12%. Conclusion The clinical manifestations of patients with liver disease complicated by SBP are diverse, the positive rate of ascites bacterial culture is low, and the PMN ratio is a reliable indicator of the diagnosis of SBP. Gram-negative bacteria mainly to the third generation cephalosporins, the third generation quinolone antibiotics sensitive.